Haem - Bain quiz cases Flashcards
Rheumatoid arthritis = associated haem abnormalities?
- Anaemia of Chronic Disease
- IDA - due to aspirin and NSAID use
- neutropenia + thrombocytopenia from drug toxicity
- Felty syndrome
- increased ESR
10yo girl with painful R knee after it was knocked in swimming pool
Afebrile
Raised ESR + CRP
X-ray showed changes on medial tibial plateau.
Most likely out of: septic arthritis/haemophilia/osteomyelitis/thrombocytopenia?
OSTEOMYELITIS - due to mild trauma and x-ray changes
Haemophilia unlikely in girl
Septic arthritis - would be febrile, with raised WCC and wouldn’t have these x-ray changes
1 year old boy with swollen right elbow following mild trauma. Normal x-ray and bloods.
3 days later = increased pain and swelling + haemorrhage fluid on joint aspiration.
4 weeks later = dark blood found on surgery and biopsy showed synovitis.
Wound bled persistently.
What test would you do?
A coagulation screen !!
Normal PTT
and prolonged APTT
Differentials for a child with a single swollen joint + bruising + effusion after trauma?
Haemophilia
Osteomyelitis
NAI
21yo woman. Abdo pain, brushing, altered level of consciousness. Low grade fever V low platelets Br ++, LDH +++ Cr +
RBC fragments
what is the Dx? : ITP/Hereditary spherocytosis/infectious hepatits/meningococcal meningitis/TTP
TTP
Why? MAHA + thrombocytopenia + fever + neuro and renal impairment
Underlying defect in TTP?
Deficiency of vWF cleaving protease –> high levels of vWF –> many platelet thrombi
In TTP - how do treat them?
Do you treat with platelets? Do you give steroids?
PLASMA EXCHANGE
do NOT give platelet transfusions or steroids
5 features of TTP
MAHA Low platelets Fever Neuro impairment Renal impairment
20yo man
fever, sore throat, malaise, SOB, abdo pain
10/7 ago he fell on left side and attended A&E with pain in left chest wall - had normal CXR
Now, he has fever + tachycardia + lymphadenopathy + inflamed pharynx + mild hepatosplenomegaly + tender abdomen.
Increased lymphocytes + anaemia.
What test would you do? How do you manage him?
Screen for infectious mononucleosis
Suspect splenic damage + intraperitoneal haemorrhage, therefore do urgent abdoUSS
What are the risks of hyposplenism? Therefore how do we manage it?
Bacterial sepsis - Vaccinate for pneumococcus + meningococcus + Hib - Prescribe life long penicillin Fatal malaria - Advise on malaria zones
- Issue a splenectomy card + info sheet
63yo man
Microcytic anemia
known GORD + rectal bleeding
Normal colonoscopy
1 yr later, had worsening aenmia, weight loss, cervical lymph node felt + later disappeared.
Ferritin was normal and CRP was v high
PMH: splenomegaly for 30 years, IHD, renal colic, gout, chronic cough, GORD
Ddx? give 3
Alpha thalassemia
Sideroblastic anemia
ACD
Pathophysiology of anaemia of chronic disease
Reduced RBC lifespan Reduced proliferation of erythroid precursors Suppressions of EPO Impaired iron utilisation Cytokine release
Tx of anaemia of chronic disease
Treat the cause
Consider giving EPO + transfusion
Smear cells
CLL
Give 3 Ddx for a 58 yo man with:
Hb+, RBC+, Hct+. Normal platelets
polycythemia secondary to hypoxia/malignancy
Psuedopolycythemia (reduced plasma volume
PRV
